Reducing unnecessary crossmatching for hip fracture patients by accounting for preoperative hemoglobin concentration  

作　　者：Raj M Amin Varun Puvanesarajah Yash P Chaudhry Matthew J Best Sandesh S Rao Steven M Frank Erik A Hasenboehler 

机构地区：[1]Department of Orthopaedic Surgery,Stanford University Medical Center,Stanford,CA 94305,United States [2]Department of Orthopaedic Surgery,Johns Hopkins School of Medicine,Baltimore,MD 21205,United States [3]Department of Orthopaedic Surgery,Philadelphia College of Osteopathic Medicine,Philadelphia,PA 19122,United States [4]Department of Orthopaedic Surgery,Massachusetts General Hospital,Boston,MD 02114,United States [5]Department of Anesthesiology,Critical Care Medicine,Baltimore,MD 21205,United States [6]Department of Orthopaedics,Johns Hopkins School of Medicine,Baltimore,MD 21205,United States

出　　处：《World Journal of Orthopedics》2021年第5期292-300,共9页世界骨科杂志（英文版）

摘　　要：BACKGROUND Maximum surgical blood order schedules were designed to eliminate unnecessary preoperative crossmatching prior to surgery in order to conserve blood bank resources.Most protocols recommend type and cross of 2 red blood cell(RBC)units for patients undergoing surgery for treatment of hip fracture.Preoperative hemoglobin has been identified as the strongest predictor of inpatient transfusion,but current maximum surgical blood order schedules do not consider preoperative hemoglobin values to determine the number of RBC units to prepare prior to surgery.AIM To determine the preoperative hemoglobin level resulting in the optimal 2:1 crossmatch-to-transfusion(C:T)ratio in hip fracture surgery patients.METHODS In 2015 a patient blood management(PBM)program was implemented at our institution mandating a single unit-per-occurrence transfusion policy and a restrictive transfusion threshold of<7 g/dL hemoglobin in asymptomatic patients and<8 g/dL in those with refractory symptomatic anemia or history of coronary artery disease.We identified all hip fracture patients between 2013 and 2017 and compared the preoperative hemoglobin which would predict a 2:1 C:T ratio in the pre PBM and post PBM cohorts.Prediction profiling and sensitivity analysis were performed with statistical significance set at P<0.05.RESULTS Four hundred and ninety-eight patients who underwent hip fracture surgery between 2013 and 2017 were identified,291 in the post PBM cohort.Transfusion requirements in the post PBM cohort were lower(51%vs 33%,P<0.0001)than in the pre PBM cohort.The mean RBC units transfused per patient was 1.15 in the pre PBM cohort,compared to 0.66 in the post PBM cohort(P<0.001).The 2:1 C:T ratio(inpatient transfusion probability of 50%)was predicted by a preoperative hemoglobin of 12.3 g/dL[area under the curve(AUC)0.78(95%confidence interval(CI),0.72-0.83),Sensitivity 0.66]in the pre PBM cohort and 10.7 g/dL[AUC 0.78(95%CI,0.73-0.83),Sensitivity 0.88]in the post PBM cohort.A 50%probability of requiring>1 RBC unit was predi

关 键 词：Hip fracture TRANSFUSION Blood conservation HEMOGLOBIN Type and cross Maximum surgical blood order schedule 

分 类 号：R687.3[医药卫生—骨科学]